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04/01/2015

NAMI report shows system has a long way to go with mental health parity

US News & World Report (4/1, Leonard) reports that the National Alliance on Mental Illness (NAMI) has issued a new report (4/1) suggesting that despite the Affordable Care Act and the Mental Health Parity Act, “insurance companies are falling short in coverage of mental health and substance abuse disorders, collectively referred to as ‘behavioral health’ services.” In arriving at the report’s conclusions, “NAMI surveyed 2,720 customers and analysed 84 health insurance plans – both employer-provided plans and ones purchased through the marketplaces – in 15 states.”

From NAMI Ohio:

NAMI released a report today which highlights problems with accessing mental health and substance abuse treatment despite passage of the federal parity law which was expanded in the Affordable Care Act. Below are the findings and recommendations included in the report. To access the report, go to: www.nami.org/parityreport.

The report findings include:

A Lack of mental health providers is a serious problem in health insurance networks.

Nearly a third of survey respondents reported insurance company denials of authorization for mental health and substance abuse care. For ACA plans, denials were nearly twice the rate for other medical care.

Barriers exist for mental health medications. More than half of health plans analyzed for the report covered less than 50 percent of anti-psychotic medications.

High out-of-pocket costs for prescription drugs appear to discourage people from participating in both mental health and other medical treatment.

High co-pays, deductible and co-insurance rates create further barriers to treatment.

There is a serious lack of information about mental health coverage to enable consumers to make informed decisions in choosing health plans.

The report is based on a "Coverage for Care" survey of 2,720 individuals with mental illness or their family members. Survey results were supplemented by an analysis of 84 health insurance plan drug formularies in 15 states conducted by Avalere Health.

The report makes four recommendations:

Strong enforcement of the 2008 parity law is needed at both federal and state levels, including establishing easily accessible procedures for filing complaints.

Insurance companies should be required to publish the clinical criteria used to approve or deny mental health and medical-surgical care.

Health plans should be required to publish accurate lists of providers included in their networks and to update them regularly.

The U.S. Department of Health & Human Services should require all health plans to provide clear understandable, yet detailed information about benefits and to make this information easily accessible. HHS should develop tools to help consumers compare plans prior to enrollment. Congress and the Executive Branch must work together to decrease out-of-pocket costs under the ACA for low-income consumers.